At YVL Medical Aesthetics, we routinely practice a few safety tips to reduce the risk of unwanted side effects or complications from Botox/Dysport injections
We normally reduce the dosage by 20% for first timers and for patients new to our practice as individual dosage requirements to Botox/Dysport may differ substantially. We opt to perform a top-up electively in 2 weeks’ time to further augment the results of the Botox/Dysport when necessary.
Forehead Wrinkle Treatment
The injection points are normally spread over 10 points evenly to evenly distribute the Botox/Dysport throughout the forehead and for an even and symmetrical result.
Wrinkle Treatment around the Eye and Eyebrow
Care is taken not to inject or direct the injection of Botox/Dysport near the eye or eyebrows, maintaining a minimum safety distance always.
This is to prevent complications like visual disturbances and ptosis (marked drooping of upper eyelid) and to date there has been no documented cases of such complications at YVL Medical Aesthetics.
Masseter/Jaw Muscle Reduction (Facial Slimming)
Dosage is adjusted based on the size of the masseter/jaw muscle and the specific injection points and dosage per point is based on individual muscle size and shape as well as desired results.
Care is taken not to inject too far forward to prevent stiffness or asymmetry/unevenness of smiling
Platysma/Neck Muscle Reduction
Superficial fine needles are used to ensure very superficial placement of Botox/Dysport and avoid diffusion to deeper tissue and structures (e.g. windpipe/food pipe).
Care is taken not to inject around the larynx/voice box to prevent any inadvertent alteration of voice and speech.
Dermal filler injections are widely performed worldwide with over twenty years of usage and safety experience for Hyaluronic Acid (HA) based dermal fillers.
However, there are known complications to dermal filler injections, many of which are potentially preventable.
At YVL Medical Aesthetics, our dermal filler complication prevention protocol includes:
Routine usage of single use gloves, sterile single use dressing sets, non-alcohol based antiseptic solution and single use hypodermic needles/cannulae are the norm for us.
All areas of injection/treatment are thoroughly cleansed and dis-infected prior to the procedure being performed.
Post-procedural care may include the application of antibiotic ointment to the injection sites, usage of oral anti-inflammatory medications and antibiotics and usage of histoacryl tissue adhesive to seal all injection marks and reduce the risk of complications.
Usage of adrenaline and blunt cannulation
At YVL Medical Aesthetics, we practice blunt cannulation as the preferred method of performing dermal fillers.
A blunt cannula refers to a flexible blunt metal tubing that is used to administer the dermal fillers. Prior administration of local anaesthetic (lignocaine) with adrenaline is performed to allow the creation of a needle hole to insert the cannula.
In trained hands, blunt cannulation allows for a marked reduction in the risk of injury to the blood vessels and filler embolism which may result in blindness. This is further enhanced by the usage of adrenaline which acts to constrict the blood vessels in the surrounding tissue and further reduce the risks.
During Botox/Dysport injection, pain arises from two sources:
At YVL Medical Aesthetics, we manage the pain from Botox/Dysport injection using the following methods:
We advocate the application of topical numbing cream prior to the procedure. When possible, numbing cream is applied for at least an hour.
The usage of numbing cream will primarily reduce the sensation of the needle puncturing the skin.
Ice is applied in addition to the area of injection immediately prior to the injection of Botox/Dysport.
The application of ice reduces both the sensation of the needle puncturing the skin as well as the pain from injection and may also help to reduce the risk of bruising.
We focus on a smooth and controlled puncture using fine 30G insulin needles. This minimizes the sensation felt during the process of the needle puncturing the skin, and sometimes cannot be felt.
The Botox/Dysport is then slowly administered at a rate of 0.01ml/second to minimize the pain/discomfort from the administration of the medication into the site of injection. Botox/Dysport is routinely pre-mixed with normal saline solution, and hence the main determinant of pain during the administration of injection is the speed of the injection.
During Dermal Filler injection, we routinely use the following measures to reduce the degree of pain or discomfort experienced:
Local anaesthetic (lignocaine) is administered to allow for the creation of a needle hole for insertion of blunt cannula.
The local anaesthetic is pH buffered so eliminate the pain associated with the acidity of lignocaine HCl.
The moment of puncture of the needle through the skin is precise and controlled and pain sensation may be brief or absent.
Only less than 0.01ml of local anaesthetic is administered and after a short pause, more local anaesthetic is then injected (the needle remains stationery and cannot be felt in the interim). This is to allow for the initial minute quantity of local anaesthetic to take effect and subsequent local anaesthetic that is injected cannot be felt.
Blunt cannula is always used in a gentle and controlled fashion, and generally does not result in much discomfort in patients with normal pain thresholds.
The control of injection speed is always practised both for safety as well as pain control. Slow injection of dermal fillers greatly reduces the pressure/swelling sensation that is experienced with rapid ‘bolus’ type injection of dermal fillers.
Rapid injections in theory have a higher risk of inadvertent injection of the dermal filler into blood vessels, which can then embolize and cause blindness or cut off blood supply resulting in necrosis (rotting) of the treatment area.
All our dermal fillers used on the face comes pre-packed with buffered lignocaine within the filler.
Other Methods of Pain Control
Pre-procedural oral painkillers and anti-anxiety medications can be used to prepare patients who are nervous, anxious or pain sensitive prior to the Botox/Dysport or dermal fillers or other procedures.
For patients who are extremely nervous, anxious or pain sensitive, YVL Medical Aesthetics does offer the option of having an anaesthetist to perform sedation and then perform the Botox/Dysport, dermal fillers and other procedures.
This is normally done in a separate licensed day surgery centre by a qualified anaesthetist and will incur additional facilities fees and anaesthetist fees.